Provider Demographics
NPI:1043296403
Name:DANSIE, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:DANSIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:869 E 4500 S
Mailing Address - Street 2:PMB 511
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3049
Mailing Address - Country:US
Mailing Address - Phone:801-487-0451
Mailing Address - Fax:801-487-2467
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-1900
Practice Address - Fax:801-662-1810
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN449482085R0202X
UT4839630-12052085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7801302OtherAETNA
UTIDX035672OtherUHN
UT48396301200001OtherBLUE CROSS BLUE SHIELD
UT21295805602OtherBEECHSTREET
UT7954833OtherCIGNA
UTA022OtherTRICARE
UT94139OtherPUBLIC EMPLOYEES HEALTH P
H44007Medicare UPIN